Meningococcal pathogenesis: at the boundary between the pre- and post-genomic eras

Meningococcal disease remains an important public health burden worldwide a nd, indeed, cause of death, particularly in poorer countries. The rapidly p rogressive nature of infections means that antibiotic therapy often comes t oo late. Vaccines are of limited efficacy in infants, one of the most vulne rable age groups, and do not exist for bacteria of serogroup B. Hence, much remains to be achieved in terms of vaccine design and the understanding of the pathogenesis of meningococcal disease. The causative bacterium, Neisse ria meningitidis, is usually a commensal of the nasopharynx, factors that l ead to the invasion of the bloodstream, often followed by the crossing of t he blood-brain barrier and meningitis, may be partly host-and partly bacter ium-dependent, but are ill-understood. It is hoped that. taken together wit h the fundamental knowledge gained from biochemical and genetic studies, th e huge amount of new information made available with the recent publication of the genome sequences will help to unlock more of the secrets of the lif estyle and pathogenic potential of this still poorly understood pathogen.